Hochstedler Baylie R, Burnett Lindsey, Price Travis K, Jung Carrie, Wolfe Alan J, Brubaker Linda
Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.
Int Urogynecol J. 2022 Mar;33(3):563-570. doi: 10.1007/s00192-021-04780-4. Epub 2021 Apr 14.
Many clinicians utilize standard culture of voided urine to guide treatment for women with recurrent urinary tract infections (RUTI). However, despite antibiotic treatment, symptoms may persist and events frequently recur. The cyclic nature and ineffective treatment of RUTI suggest that underlying uropathogens pass undetected because of the preferential growth of Escherichia coli. Expanded quantitative urine culture (EQUC) detects more clinically relevant microbes. The objective of this study was to assess how urine collection and culture methods influence microbial detection in RUTI patients.
This cross-sectional study enrolled symptomatic adult women with an established RUTI diagnosis. Participants contributed both midstream voided and catheterized urine specimens for culture via both standard urine culture (SUC) and EQUC. Presence and abundance of microbiota were compared between culture and collection methods.
Forty-three symptomatic women participants (mean age 67 years) contributed specimens. Compared to SUC, EQUC detected more unique bacterial species and consistently detected more uropathogens from catheterized and voided urine specimens. For both collection methods, the most commonly detected uropathogens by EQUC were E. coli (catheterized: n = 8, voided: n = 12) and E. faecalis (catheterized: n = 7, voided: n = 17). Compared to catheterized urine samples assessed by EQUC, SUC often missed uropathogens, and culture of voided urines by either method yielded high false-positive rates.
In women with symptomatic RUTI, SUC and assessment of voided urines have clinically relevant limitations in uropathogen detection. These results suggest that, in this population, catheterized specimens analyzed via EQUC provide clinically relevant information for appropriate diagnosis.
许多临床医生利用清洁中段尿标准培养来指导复发性尿路感染（RUTI）女性患者的治疗。然而，尽管进行了抗生素治疗，症状可能持续存在且病情频繁复发。RUTI的周期性特点及治疗效果不佳表明，由于大肠杆菌的优势生长，潜在的尿路病原体未被检测到。扩展定量尿培养（EQUC）能检测出更多具有临床意义的微生物。本研究的目的是评估尿液采集和培养方法如何影响RUTI患者的微生物检测。
这项横断面研究纳入了已确诊为RUTI的有症状成年女性。参与者通过标准尿培养（SUC）和EQUC提供中段尿和导尿标本进行培养。比较了培养方法和采集方法之间微生物群的存在情况及丰度。
43名有症状的女性参与者（平均年龄67岁）提供了标本。与SUC相比，EQUC检测到更多独特的细菌种类，并且始终能从导尿和中段尿标本中检测到更多的尿路病原体。对于两种采集方法，EQUC检测到的最常见尿路病原体是大肠杆菌（导尿：n = 8，中段尿：n = 12）和粪肠球菌（导尿：n = 7，中段尿：n = 17）。与通过EQUC评估的导尿样本相比，SUC常常漏检尿路病原体，且两种方法对中段尿进行培养均产生较高的假阳性率。
在有症状的RUTI女性中，SUC和中段尿评估在尿路病原体检测方面存在临床相关局限性。这些结果表明，在这一人群中，通过EQUC分析的导尿标本可为准确诊断提供临床相关信息。
